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This article discusses the interactions with so-called "difficult" parents, who often suffer from mental illness that has never been treated. The article offers recommendations to decode the emotional communication of such parents who doubt their own ability to care for their children as well as that of the pediatrician's. A clinical case is presented of a mother who "can't take it anymore" with her three-year-old son, in order to focus in greater depth on improving interactions with the physician. The authors strongly recommend assessment of what parents say about their child as well as of first-hand observations of parent-child interactions. Approaches to help the pediatrician better evaluate parental distress and associated risks to the child, while maintaining the parent-pediatrician alliance, are discussed.